{"id":565,"date":"2012-02-06T18:22:52","date_gmt":"2012-02-06T22:22:52","guid":{"rendered":"http:\/\/www.khpi.org\/blog\/?p=565"},"modified":"2012-02-11T12:07:53","modified_gmt":"2012-02-11T16:07:53","slug":"loss-of-medical-privacy-is-that-ok","status":"publish","type":"post","link":"http:\/\/www.khpi.org\/blog\/loss-of-medical-privacy-is-that-ok\/","title":{"rendered":"Loss of Medical Privacy? Is that OK?"},"content":{"rendered":"

Yesterday, Phil Galewitz reported for Kaiser Health News<\/a> (reprinted in USA Today) on a practice that is one of my biggest disappointments in our health care system, the sale of our personal health information for the benefit of someone else.\u00a0 I do not mean the use of de-identified medical information to improve public health, medical quality, enhancement our ability to treat disease, or even for law enforcement.\u00a0 I am talking about the use of your individual health information to try to sell you something else that you may or not need.\u00a0 Did you ever wonder why all of a sudden you started getting ads for diabetes supplies?\u00a0 Or why ads for erectile dysfunction started arriving in your mailbox as well as your email?\u00a0 It is because your personally identifiable medical information is being shared to improve the bottom lines of those who have access to your medical records.\u00a0 The story highlighted the practices of hospitals that use information from their medical records to peddle other services to their current or former patients\u00a0 Partnering with mass marketing companies, your hospital knows a lot more about you than is present in their records. \u00a0For example, if you smoke, you get a directed ad for lung cancer screening. \u00a0 Believe me, when you come in for a \u201cscreening,\u201d something can almost always be found that \u201dneeds\u201d to be done.\u00a0 \u00a0 Screening can be a hospital\u2019s or doctor\u2019s best friend.\u00a0 It all depends on how ethical or financially strapped the provider is that determines how far evidence-based scientific medical practice will be stretched.\u00a0 Examples of abuse are easy to find.<\/p>\n

I have some personal experience with these marketing practices, and so do you.\u00a0 For many years, my neighborhood drugstore printed advertisements on my receipts trying to induce me to buy more expensive drugs or treatments.\u00a0 The drugstore knew what individualized ads to print because they had my drug and diagnosis history.\u00a0 The conflict of interest bothered me, but I tried to ignore it.\u00a0 I took a brand-name antihistamine prescribed for me by my physician.\u00a0 Because I did not want to bother my doctor, I once wrote my own prescription renewal.\u00a0 [I know that is not a good idea, but we are not talking about Percodan\u00ae here, and the drug was soon slated to go over-the-counter.]\u00a0 As soon as the brand name drug went off-patent, I got two direct letters from a drug company trying to convince me that their new and expensive brand-name drug was much better for me than the old drug that had just the month before been marketed with equal enthusiasm as God\u2019s gift to the allergic, and even great for kids in school because it would not make them sleepy.\u00a0 The kicker is that I got a letter as both the patient and the doctor. \u00a0 As you might imagine, indignant Peter called the corporate headquarters of the drugstore to complain and find out how the drug company knew I was taking the drug, and that it was none of their business.\u00a0 The company told me that they did not reveal my name to the drug company and that the correspondence was paid for by a grant from the drug company to a third party marketing business partner of the drug store.\u00a0 To me that was a distinction without a difference.\u00a0 In a world where every square inch of our local sports arena seems covered with advertising; and every play, timeout, basket, or injury seems to have some sponsor attached to it, you can imagine how valuable your personal health information is.\u00a0 Just as the temptation to cheat cannot always be denied in sports, so can you assume that someone, somewhere is trying to play games with your information and your health.<\/p>\n

It is not just self-righteous Peter that gets exercised by these practices: grass-roots doctors are also unhappy.\u00a0 Not long ago, the Greater Louisville Medical Society passed a resolution calling the sale of physician prescribing information to drug companies and other third parties\u00a0unethical<\/em> and demanding an end to the practice.\u00a0 (We don\u2019t use the term \u201cunethical\u201d as often as we should in our profession!) \u00a0 However, the local society was overruled by the leadership of the Kentucky Medical Association (KMA) because the parent AMA makes millions of dollars doing exactly the same thing. \u00a0 I hope that personal advancement in the national organization was not one of the reasons the KMA blocked Louisville’s resolution but how can we know? \u00a0But that\u2019s exactly the problem with even perceived conflict of interest such as we are writing about today.<\/p>\n

Your medial information has always been available for the use of others without your knowledge. \u00a0\u00a0When I became Medical Director of a large managed care company in Louisville some years ago, I was surprised by requests from employers for information about their employees.\u00a0 Such requests had apparently previously been honored.\u00a0 For example, one large hospital employer wanted to know as soon as any of their employees became pregnant.\u00a0 The justification was that the employee could be encouraged to enter maternal wellness programs.\u00a0 Of course the hospital would then also know which of their employees might have a subsequent miscarriage or abortion.\u00a0 Doesn\u2019t that freak you out? \u00a0 It did me.\u00a0 I refused that request and all subsequent ones for personal health information. \u00a0 \u00a0I had and still have no confidence that the employers were ultimately denied what they wanted to know. After all, it is they and not the employee\/patients who are the primary customers of insurance companies. \u00a0The often-complained-about new privacy laws in HIPPA were written for a good reason. \u00a0 I hope things are better now with the way that medical information is handled in our system of many operators, but we cannot know unless we have more transparency, and that is lacking. \u00a0What I see are end-runs and work-arounds such as used by the hospitals in this story. \u00a0(The drug companies lobbied for and got special exemptions in HIPPA.)<\/p>\n

So why is such sharing and marketing such a bad thing?\u00a0 The hospitals interviewed for the article claim that they only want to improve access and that they are providing \u201ceducation\u201d about things that are good for their patients.\u00a0 They acknowledge they are marketing only their most profitable services and justify the practice as a means to provide less profitable services to others\u00a0 After all, more is better\u2013 right?<\/p>\n

Wrong!\u00a0 The problems are legion and exceed both the time and space available here. Just off the top of my head:<\/p>\n

\u2022 Even if the offerings were medically justified, targeting only those with high-paying insurance discriminates against the uninsured, the underinsured, those with high-deductible insurance, or those with Medicare or Medicaid.\u00a0 Federal or state government or any managed care company worth their salt would not stand for this for a second.\u00a0 Hospitals should not be in the business of discriminating.\u00a0 All who walk in the door should expect equal treatment.<\/p>\n

\u2022 The practice of direct marketing to the patient cuts out or devalues the judgement of any physician advisor the patient might have.\u00a0 Just because the drug companies have gotten away with it doesn\u2019t make it right.\u00a0 Remember too that all the hospitals in Louisville, and presumably elsewhere, have hired their own doctors.\u00a0 Getting your regular doctor\u2019s council or approval is no longer necessary to use a hospital\u2019s facilities.\u00a0 These employee doctors will participate in the testing and procedures. They will unavoidably be also thinking about their own salaries and jobs.\u00a0 Doctors were lying to themselves when we claimed that drug company connections and money did not affect our practice behaviors.\u00a0 We are lying to ourselves \u00a0again, and to you, if we maintain that being employees of a hospital will have no effect on how we practice.\u00a0 Wouldn’t you rather have no doubt \u00a0that we work for you alone?<\/p>\n

\u2022 If hospitals were really interested in serving the public, they would promote things they were good at, not just things that made them the most money.\u00a0 They would back up their competence with facts, not marketing puffery. \u00a0Our hospitals deserve our absolute trust, but in today’s climate, they need to earn it.<\/p>\n

\u2022 When I was researching such things, every study I read determined that when physicians had a financial interest in the testing, equipment, or facilities they used, that they spent more of their patients money: 30% more is the average I remember.\u00a0 None of those studies claimed that the extra services were medically necessary.\u00a0 Why does not the principle involved apply also to hospitals? \u00a0 If your eye is always on the bottom line, there is no question that unnecessary medical services will result.<\/p>\n

\u2022 Screening in particular is subject to the greatest abuse. \u00a0Screening may be defined as testing people who have no symptoms of disease. \u00a0In a limited number of conditions, screening can be justified. \u00a0However, you get, as do I, ads from one mobile screening service or another offering a broad assortment of tests for various health conditions.\u00a0 Sometimes hospitals are involved.\u00a0 I have never personally seen these promotions justified, let alone recommended by any respected medical authority. (Presumably the licensed doctors who read the tests somewhere do not object.)\u00a0 Everything I have ever learned or believed in as a physician screams out against such \u201cscreening.\u201d\u00a0 Shotguns are used for killing, not for healing. \u00a0 Some people will be unnecessarily harmed and killed by complications and misadventures resulting from poorly targeted medical testing.\u00a0 Hospitals can be guilty of over-serving their patients. Every time you go into a hospital there is a chance you will not come out.\u00a0 You must<\/span> have to have a good reason to go in.\u00a0 Nothing<\/span> in medicine is perfectly save.<\/p>\n

\u2022 I have little doubt that hospitals are categorizing the marketing expense of these endeavors\u00a0 as \u201ceducation\u201d and are applying the sums towards the community benefit they must prove in order to maintain their non-profit advantages. \u00a0 I say, use the money to provide healthcare for the under-served for whom your favorable tax status was granted.\u00a0 The retort will be the standard, \u201cno margin, no mission.\u201d\u00a0 That is to say, the ends justify the means: we have to make money somewhere. \u00a0It might seem hard to argue with that, but this is no basis on which to build a good medical care system.\u00a0 I say that if you have to depend on gimmicks and unnecessary medical services to stay open, then you need a different business model or you should close your doors and let someone else try.<\/p>\n

\u2022 The nature of the promotional material itself used by hospitals sometimes seems written by marketing or movie companies rather than by medically trained professionals.\u00a0 Just yesterday I read an ad in the Louisville paper that told any woman that if they had any single one of the symptoms of neck pain, jaw pain, backache, nausea, or dizziness they should call 911 and go to one of their hospital\u2019s emergency rooms immediately.\u00a0 I can\u2019t read the ad any other way.\u00a0 Yes, those individual symptoms can be part of the constellation of symptoms that occur in the setting of a heart attack, but they are also symptoms of being alive.\u00a0 In my opinion such advertising represents scaremongering.\u00a0 Some people will actually respond to this misinformation the next time they have their inevitable back pain.\u00a0 Some time ago, I received a personal mailing at home from the same hospital using similar medically misleading language about heart attack.\u00a0 It was attached to a simulated stick of dynamite to emphasize the importance of my decision.\u00a0 I considered the promotion scaremongering then, and I still do. \u00a0I would have hoped that the leopard might have changed it spots.\u00a0 This stuff seems just plain wrong.\u00a0 Please, some physician, any physician\u2013 help me understand why I should not believe this to be a\u00a0badly misleading advertisement\u00a0if not unethical\u00a0? \u00a0Use the comment section below so others can be convinced as well.\u00a0 I very much want your advice so I can make any appropriate apology that is indicated.<\/p>\n

\u2022 Finally, but certainly not least, in the marketing I have received personally, I was not told how or why I was targeted.\u00a0 In the medical business, we call that failure to give complete informed consent.\u00a0 Financial conflicts of interest have always been with us in medicine.\u00a0 We have dealt with it (not very successfully in my view) by worshiping the goddess of honest transparency and disclosure.\u00a0 I am not seeing that here.\u00a0 All bets are off.\u00a0 It is back to caveat emptor<\/em>\u2013\u00a0 let the patient beware? \u00a0 I ask again as a patient, \u201cwho is on our side?\u201d<\/p>\n

Today in Louisville and obviously all around the country, your personal medical information is being sold or used with your name attached to it for someone else\u2019s private interests.\u00a0 Maybe it is not yet illegal because the companies involved call themselves \u201cpartners\u201d to justify the sharing. \u00a0 I don\u2019t know about you, but I don\u2019t want to have any hidden partners involved in my health care. \u00a0The emphasis on electronic medical records makes it easier to share, or for that matter, steal your personal medical information. \u00a0Are there other reasons why the practices described by Mr. Galewitz are wrong?\u00a0 Why might they be acceptable? \u00a0 If you have personal knowledge of other examples of loss or abuse of medical privacy in Kentucky or elsewhere, please also leave a comment, or contact me privately.\u00a0 I will not reveal your identity. Your email address does not appear to the public in a comment.\u00a0 You can be provocative (I want to be!) but be civil.\u00a0 If there is interest, I will elaborate, add, or respond.<\/p>\n

Peter Hasselbacher
\nFeb 6, 2012<\/p>\n

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